摘要
目的探讨尿NT-proBNP在慢性心力衰竭（chronic heart failure，CHF）中的变化规律，与心功能分级的相关性，进一步探讨尿NT—ProBNP对慢性心力衰竭的诊断价值。方法49例入院治疗的CHF患者（NYHAⅡ－Ⅳ级）和24例健康体检者，测定血NT-proBNP、尿NT—ProBNP，超声心动图检测左室舒张末室间隔厚度、左室舒张末期内径、左室收缩末期内径、左室射血分数。结果①CHF组尿NT-proBNP水平和血NT—proBNP水平明显高于正常对照组，分别为（65．47±41．34）Pg／ml vs （17．95±7．22）pg／ml，（3204．47土2067．34）pg／ml vs （40．60±15．38）pg／ml，P均〈0．01。尿NT—proBNP水平与血NT—proBNP水平呈正相关（r=0．639，P〈0．001）②随心功能的恶化，尿NT-ProBNP水平逐渐升高。尿NT-ProBNP与NYHA分级、左室舒张末期内径呈正相关（P均〈0．001），与左室射血分数呈负相关（P〈0．001）多元逐步回归分析显示与logNT-proBNP独立相关的变量是血NT-proBNP、左室射血分数及NYHA分级。③尿NT-proBNP、血NT—ProBNP对CHF诊断价值以ROC曲线下面积表示，分别为0．837（95％可信限：0．758～0．952）、0．883（95％可信限：0．809～0．963）。④根据ROC曲线，以诊断CHF的敏感度与特异度之和的最高值作为截断值，尿NT-proBNP的截断值为19．01Pg／ml。结论①在正常人和CHF患者尿中可检测到NT-proBNP。②CHF患者尿NT—proBNP水平明显高于对照组，而且尿NT-proBNP水平与血NTrproBNP水平呈正相关。③CHF患者随心功能的恶化（NYHAⅡ～Ⅳ级），尿NT—proBNP水平逐渐升高。尿NT—ProBNP水平与LAD无相关性，与LVEDD、NYHA分级呈正相关，与LVEF呈负相关。④尿NT—ProBNP在检测CHF中与血NT-ProBNP具有相似的诊断价值。
Objective To study the change of the urine NT-proBNP levels in chronic heart failure （CHF） and the relationship with heart function, and to investigate the diagnostic value of urine NT-proBNP levels in CHF. Methods 49 patients admitted with CHF （New York Heart Association[NYHA] class Ⅱ-Ⅳ） and 24 healthy persons were included. Urine NT-proBNP levels were measured. Interventricular septum thick （IVST）, left ventricular end-dias- tolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD） and left ventricular ejection fraction （LVEF） were measured by echocardiology. The patients were functionally classified according to the NYHA criteria. Results （1）The levels of urine NT- proBNP and plasma NT-proBNP were much higher in patients with CHF than in healthy persons, （65.47±41.34）pg/ml vs（17.95±7.22）pg/ml, （3204.47±2067.34）pg/ml vs（40.60±15.38）pg/ml,respectively. P〈0.01. Urine NT-proBNP levels correlate with plasma NT-proBNP levels （r = 0.639, P〈0.001）.（2）There were significant differences in the concentrations of urine NT- proBNP with more severe symptoms （NYHA class Ⅱ-Ⅳ）. Urine NT-proBNP levels were all positively related with NYHA class, LVEDD （P〈0. 001） and negatively related with LVEF （P〈0.001）.Multiple regression analysis showed the variables independently associated with logNT-proBNP were NYHA class, LVEF and plasma NT-proBNP.（3）Urine NT-proBNP level had an area under the receiver operating characteristic curve （AUC） of 0.837 （95%CI： 0.758-0.952） for diagnosing CHF. And the AUC is 0.883 （95%CI： 0.809-0.963） for plasma NT-proBNP level in diagnosing CHF.（4）The cut-off value was determined as the level with the largest sum of sensitivity plus specificity on each of the receiver operating characteristic curves. The urine NT-proBNP level was 19.01pg/ml. Conclusions （1）Urine NT-proBNP was measurable in healthy persons and in patients with CHF.（2）Urine NT-proBNP levels were much higher in patients with CHF than in healthy persons, correlating with plasma NT-proBNP levels.（3）Urine NT-proBNP levels were elevated in the more severe functional classes and were all positively related with NYHA class, LVEDD and negatively related with LVEF.（4）Urine NT-proBNP provides a similar accuracy in the detection of CHF as plasma NT-proBNP.
出处
《国际医药卫生导报》
2008年第20期5-12,共8页
International Medicine and Health Guidance News
基金
广州市卫生局科研项目（编号：2006-YB-050）
关键词
心力衰竭
脑利钠肽
诊断
Heart failure Brain atrial natriuretic peptide Diagnosis
